The most important goal of any acne treatment is prevention of scarring.Acne scarring arises from skin textural changes (e.g. divots, ice-pick scars, boxcar scars) as well as pigmentary changes (e.g. redness or hyperpigmentation). To prevent skin textural scarring, it is critical to prevent and avoid manipulation of inflammatory acne lesions, namely cysts and nodules which are often tender to touch. Our at California Dermatology Care by Dr. Ting and the rest of the clinical team is to keep your complexion clear with the least amount of oral systemic medication whenever possible. However, in many cases, topical medications alone may not be sufficient to control inflammatory lesions. For more resistant and inflammatory acne, Dr. Ting may utilize oral antibiotics such as doxycycline, minocycline, or trimethoprim and sulfamethoxazole to achieve maximal anti-inflammatory effects and/or hormonal medications such as birth-control pills or spironolactone to minimize hormonal trigger. Symptomatic and tender cysts may be treated with intralesional steroid injection. For patients who failed conventional topical and oral acne therapy, Dr. Ting may recommend photodynamic therapy or isotretinoin (Accutane) as a last resort.

Once your acne is in remission, we will review all options to improve remaining acne scarring. Intralesional steroid injection of hypertrophic scars may be performed if warranted. Potent and gentle bleaching creams (with or without hydroquinone) are available to fade pigmentation.

Dr. Ting and the team are among the most experienced laser surgeons for scar revision in Northern California. He is known for his expertise in Fractional CO2 laser resurfacing for both fair skin and ethnic skin individuals. In addition, we are first in the San Francisco Bay Area and the Northern California to introduce Picosure (755nm Alexandrite laser energy delivered in picoseconds) for acne scarring. All laser therapy for acne scarring will be enhanced when preceded by minimally invasive subcision to release tethered scar tissues that otherwise pull the skin downward. We also are experienced in reducing red or pink scarring for fair skinned individuals using VBeam Perfecta and Excel V lasers.

Fractional CO2 laser resurfacing for Acne Scar Revision

Fractional CO2 laser is the gold standard for acne scar revision for those who can afford a week of social downtime. 10060nm CO2 laser energy is delivered in pixel-like fashion where microscopic 0.3mm holes are drilled into the skin right next to each other via computer-generated pattern. In so doing, we have microscopic columns of CO2 laser energy getting delivered underneath the skin to stimulate collagen production and skin scar tissue remodeling. For ethnic skin individuals, pre-treatment is necessary with combination of topical retinoid and hydroquinone to minimize post-treatment pigmentation.

Before 12 months after Fractional CO2 Laser

Before 6 weeks after Fractional CO2 Laser + subcision

Picosure Laser for Acne Scar revision

Picosure Laser by Cynosure is the most potent nonablative laser for scar revision. The revolutionary core technology derives from technological breakthrough of delivering Alexandrite 755nm laser energy in picoseconds (trillionths of a second) where greater scar remodeling and reduction of pigmentation and pores can be achieved with minimal downtime. Most patients report mild pinkness for a day with some scaling. Best clinical results can be obtained with series of 5-6 treatments 4 weeks apart with or without subcision. This laser can be performed for ethnic skin individuals as well with no need for topical pretreatment.above 4 photos provided by Cynosureabove photo adopted from Andrea Catton Laser Clinic, UK

GenesisPlus Laser for Acne Scar revision

GenesisPlus laser by Cutera is by far the most versatile laser delivering gentle Nd:Yag 1064nm energy with minimal discomfort and no downtime. Over a series of treatment, particularly combined with subcision, we can achieve effective scar tissue remodeling with shrinkage of pore size and reduction of skin pigmentation and redness. Optimal clinical results can be obatined with a series of 6-8 treatments 2-4 weeks aparts. This laser can be performed for all skin types without topical pretreatment.
Before and After 2 treatments of Cutera GenesisPlus preceded by Subcision

Before and after photos after 3 treatments of GenesisPlus Laser

Before and after photos after 6 treatments of GenesisPlus Laser

Before and after photos after 6 treatments of GenesisPlus Laser

Before and after photos after 2 treatments of Spectra Laser

Before and After Photos of Spectra Laser Acne Reduction and Scar Revision

Ultherapy 1.5mm transducer for Acne Scar revision

Ultherapy 1.5mm transducer is an innovative way to achieve pore size reduction and scar remodeling by delivering ultrasonic energy along subcutaneous tissue plane. Classically, Ultherapy utilizing 3.5mm and 4.5mm transducers targeting muscles and subcutaneous tissue is indicated for face, neck, chest skin tightening and lifting as well as promoting collagen production. Dr. Ting's clinical team has unique experience in performing Ultherapy 1.5mm transducer for reduction of acne scarring for all skin types without downtime. The procedure can be augmented with preceding subcision.

Frequently Asked Questions (FAQ) about Acne

I have ethnic skin, what are my laser options for acne scar revision and acne pigment reduction without downtime?

We are proud to offer 5 state of the art technologies including Picosure Laser, Ultherapy 1.5mm transducer, GenesisPlus Laser, Clear and Brilliant Laser and Spectra Laser that have strong clinical track records to reduce acne scarring, shrink pore sizes by stimulating collagen remodeling without any associated down time. These lasers are safe, effective and without downtime for both fair-skin and ethnic skin individuals without any season restriction. Dr. Ting and the team offer the most advanced and comprehensive technologies in San Francisco Bay Area and entire Northern California for acne scar reduction for all skin types.

I have fair skin, what is my laser option for reduction of red acne scar and scar revision without downtime?

VBeam Perfect pulse dye laser is your best option in reducing red acne scar by targeting red blood cells and stimulate scar remodeling and collagen production. There should not be any downtime associated with VBeam Perfecta. Cutera GenesisPlus laser is a fine option as well to reduce both red and pigmented acne scarring in addition to pore size reduction, scar remodeling and collagen production.

I have enlarged pores, what are my options for pores size reduction?

Topical retinoids (such as tretinoin, adapalene or tazoratene) is traditionally recommended to apply on the skin to prevent pore size enlargement. However, not everyone can tolerate application of topical retinoids on a regular basis. While Picosure Laser, Ultherapy 1.5mm transducer, and GenesisPlus laser can be quite effective, Spectra Laser peel is unique in its ability to achieve pore size reduction via application of lipophilic carbon lotion, which guides the q-switched Nd:Yag laser to target hair follicles and thereby effectively shrink pore size over series of 5-6 monthly treatments.

How does photodynamic therapy (PDT) work for acne? PDT works through photochemical reaction between Levulan (naturally-occurring break down compound of red blood cell) and Blu-U light source (~410nm wavelength) which (1) eradicates p. acnes bacteria which are responsible for triggering inflammation around hair follicles and (2) reduces activities of the oil glands thereby minimizing oily complexion. Dr. Ting has treated more than 3,000 patients with photodynamic therapy (PDT) for acne and other indications for the past several years. PDT has become a great alternative for patients who wants to augment their conventional therapies of oral antibiotics and topical medicated creams and to avoid Accutane. Dr. Ting and the clinical team has the experience to precisely prescribe the appropriate mix of incubation time (duration of Levulan application on face) and exposure time (duration of Blu-U light source exposure) to maximize the clinical results and minimize discomfort.

Does diet matter?Maybe. There are recent medical literature that suggests non-organic dairy products such as milk, cheese, yogurts, and ice cream may exacerbate acne. Nowadays, many milk cows are given shots of growth hormones and it is thought that subsequent absorption of these growth hormones via consumption of non-organic dairy products may trigger excessive sebaceous gland activities on the skin. Also, there is evidence that diets high in glycemic content, e.g. candy bars and some soft drinks, may predispose one to have more acne lesions. In short, try to consume only organic dairy products and avoid food items that are rich in sugar content. Most recently, a publication out of Journal of American Academy of Dermatology confirmed a dose-response correlation between chocolate intake and severity of acne activities.

Does oral antibiotics make oral contraceptive pills (OCP) less effective?There is a common misconception that oral antibiotics make OCPs less efficacious in preventing pregnancy. In general, the failure rate of OCPs is in excessive of 1%. The best clinical studies have not demonstrated significant impact made by oral antibiotics to the effectiveness of OCPs. If it is critical that pregnancy be prevented while taking both OCP and oral antibiotics, Dr. Ting suggests that you should use a backup method for contraception such as male latex condom.

How important is face wash for acne?
Cleaning one’s face is an important part of the acne skin care routine, particularly at the end of the day to remove dirt, perspiration, skin debris, and makeup (if applicable). Dr. Ting will recommend a specific face wash depending on your skin type (oily vs. dry, redness vs. pigmented). Most of us spend no more than 2 seconds washing our face. Therefore, utilizing Clarisonic brush as part of your skin cleansing routine can be quite helpful which forces you to wash your entire face and clean the pores for 60 seconds via ultrasonic vibration.

What to do with acne in the setting of sensitive/dry skin?
Dr. Ting will customize a skin care routine which incorporates gentle face wash and minimally irritating topical acne prescription medications. Most over-the-counter moisturizers may be too greasy for acne-prone skin. Therefore, Dr. Ting recommends application of Dermesis toner/cream (derived from research done at a UCSF lab) which facilitates skin barrier repair by replenishing calcium ions externally.

What to do for women who experience hormonal trigger of acne?Hormonal influence of acne in women is strongly suggested by the presence of inflammatory acne lesions in the perioral and jawline regions of the face. In fact, many women report premenstrual flare of acne. Two of the most efficacious adjunctive OCP therapy for acne are Yasmin and Yaz. Both medications contain drosperidone which is an anti-androgen and can mitigate hormonal trigger of acne for women. As an alternative, spironolactone may be considered as it is a potent anti-androgen medication and can effectively mitigate hormonal influence in acne for women. While on spironolactone, Yasmin or Yaz, one should avoid diets high in potassium content (e.g. banana, kiwi fruits, avocado, sports drink such as Gatorade or Propel) to minimize symptoms of hyperkalemia which may be manifested by muscle cramps, tingling sensation or even heart palpitation). Higher doses of spironolactone may infrequently lead to menstrual irregularity and/or breast tenderness, both of which will resolve once spironolactone is discontinued. Spironolactone is compatible with most oral contraceptives and when taken concurrently, there will be less risk of irregular menstrual cycle.